title: An international survey of cytomegalovirus prevention and treatment practices in intestinal transplantation.
abstract: BACKGROUND
  Practice variation regarding cytomegalovirus (CMV) prevention and treatment across intestinal transplantation (IT) programs is unknown.
  
  
  METHODS
  An electronic survey was sent to IT programs registered with the Intestinal Transplant Association. Proportions were analyzed for categorical variables; means and SDs were analyzed for continuous variables.
  
  
  RESULTS
  Seventy-seven percent of IT programs responded to the survey. For CMV D+/R- recipients, 39.1% programs used universal prophylaxis (UP), 8.7% preemptive strategy (PE), and 52.2% hybrid strategy. For CMV R+ recipients, 45.8% programs used UP, 12.5% PE, 37.1% hybrid strategy, and 4.2% none. For CMV D-/R- recipients, 39.1% programs used UP, 21.7% PE, 26.1% hybrid strategy, and 13% none. Frequency of monitoring for PE was weekly 71.4% of programs, every 2 weeks 21.4%, and monthly 7.1%. For CMV viremia, syndrome and disease, the most common first-line agents used were ganciclovir (100% and 96.2%) and valganciclovir (23.1%) and the second-line agent was foscarnet (73.1% and 84.6%). Immunoglobulins were administered in 65.4% of the programs for pneumonia (69.2%), meningoencephalitis (50%), enteritis (46.2%), colitis (38.5%), syndrome (42.3%), viremia (30.8%), and resistant/refractory infections (11.5%).
  
  
  CONCLUSIONS
  Prophylaxis and hybrid strategy were the most commonly used. Treatment practices were consistent and mainly involved ganciclovir as first-line agent and foscarnet as second-line agent. The use of immunoglobulins appeared to be more common than in other allografts.
authors.affiliation: 1 Transplant Infectious Diseases Program, University of Nebraska Medical Center, Omaha, NE. 2 Transplant Surgery Division, University of Nebraska Medical Center, Omaha, NE. 3 Transplant Surgery, Cleveland Clinic, Cleveland, OH. 4 Biostatistics Department, University of Nebraska Medical Center, Omaha, NE. 5 Address correspondence to: Diana F. Florescu, M.D., Transplant Infectious Diseases Program, University of Nebraska Medical Center, 985400 Nebraska Medical Center, Omaha, NE 68198.
authors.forename: Diana F
authors.initials: DF
authors.lastname: Florescu
authors.forename: Kareem
authors.initials: K
authors.lastname: Abu-Elmagd
authors.forename: David F
authors.initials: DF
authors.lastname: Mercer
authors.forename: Fang
authors.initials: F
authors.lastname: Qiu
authors.forename: Andre C
authors.initials: AC
authors.lastname: Kalil
mesh_terms: D000361:Agammaglobulinemia / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology; D000998:Antiviral Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001208:Asia; D002985:Clinical Protocols; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000517:prevention & control* / Q000821:virology; D004334:Drug Administration Schedule; D005060:Europe; D019983:Guideline Adherence; D019538:Health Care Surveys; D006801:Humans; D007136:Immunoglobulins / Q000008:administration & dosage* / Q000009:adverse effects; D007422:Intestines / Q000637:transplantation*; D009656:North America; D016377:Organ Transplantation / Q000009:adverse effects* / Q000592:standards; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards; D016730:Program Development; D013020:South America; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D007136:Immunoglobulins